POP QUIZ!! What does CMS stand for? What does HIPAA stand for? Which is a record of all of your visits with one doctor, EMR or EHR? Documents in a medical.

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Presentation on theme: "POP QUIZ!! What does CMS stand for? What does HIPAA stand for? Which is a record of all of your visits with one doctor, EMR or EHR? Documents in a medical."— Presentation transcript:

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POP QUIZ!! What does CMS stand for? What does HIPAA stand for? Which is a record of all of your visits with one doctor, EMR or EHR? Documents in a medical file are considered what kind of documents? In a patient’s chart, if something is SUBJECTIVE, what does that mean?

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POP QUIZ!! What does CMS stand for? –C–Centers for Medicare and Medicaid Services What does HIPAA stand for? –H–Health Insurance Portability and Accountability Act Which is a record of all of your visits with one doctor, EMR or EHR? –E–Electronic MEDICAL Record Documents in a medical file are considered what kind of documents? –L–Legal documents In a patient’s chart, if something is SUBJECTIVE, what does that mean? –I–It’s in their own words.

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2 HIPAA, HITECH, and Medical Records Lecture 2

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2.3 Covered Entities and Business Associates 2-12 Electronic data interchange (EDI)—system-to- system exchange of data in a standardized format The electronic exchange of health care information is called a transaction

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2.4 HIPAA Privacy Rule (Continued) 2-15 Minimum necessary standard—taking reasonable safeguards to protect PHI from incidental disclosure Designated record set (DRS)—CE’s records that contain PHI Notice of Privacy Practices (NPP)—description of a CE’s principles and procedures related to the protection of patients’ health information For use or disclosure other than for TPO, a CE must have the patient sign an authorization

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2.4 HIPAA Privacy Rule (Continued) 2-16 Health information can be released for reasons other than TPO in some cases – Subpoena—order of a court for a party to appear and testify – Subpoena duces tecum—order of a court directing a party to appear, testify, and bring specified documents or items – De-identified health information—medical data from which individual identifiers have been removed

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2.6 HITECH Breach Notification Rule 2-18 HITECH Act requires CEs to notify affected individuals following the discovery of a breach of unsecured health information Breach—impermissible use or disclosure of PHI that could pose significant risk to the affected person Breach notification—document notifying an individual of a breach

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2.8 Fraud and Abuse Regulations 2-20 HIPAA created the Health Care Fraud and Abuse Control Program to uncover and prosecute fraud and abuse The HHS Office of the Inspector General (OIG) has the task of detecting health care fraud and abuse and enforcing all the related laws – Has the authority to investigate suspected fraud cases and to audit the records of physicians and payers – Audit—formal examination of a physician’s records

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2.8 Fraud and Abuse Regulations (Continued) 2-21 Qui tam—cases in which a relator accuses another party of fraud or abuse against the federal government Relator—person who makes an accusation of fraud or abuse